National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries

Felix Teufel (), Pia Roddewig, Maja E. Marcus, Michaela Theilmann, Glennis Andall-Brereton, Krishna Aryal, Sina Azadnajafabad, Pascal Bovet, Maria Dorobantu, Farshad Farzadfar, Corine Houehanou, Abla Sibai, Andrew C. Stokes, Demetre Labadarios, Mongal Gurung, Jutta Jorgensen, Khem Karki, Nuno Lunet, Sahar Saeedi Moghaddam, Kibachio J. Mwangi, Lela Sturua, Till Bärnighausen, David Flood, Pascal Geldsetzer, Albertino Damasceno, Justine Davies, Sebastian Vollmer, Mohammed K. Ali, Jennifer Manne-Goehler and Caroline Bulstra
Additional contact information
Felix Teufel: Emory University
Pia Roddewig: University of Goettingen
Maja E. Marcus: Brigham and Women’s Hospital
Michaela Theilmann: Brigham and Women’s Hospital
Glennis Andall-Brereton: Caribbean Public Health Agency
Krishna Aryal: University of Bergen
Sina Azadnajafabad: Tehran University of Medical Sciences
Pascal Bovet: Ministry of Health
Maria Dorobantu: University of Medicine and Pharmacy Carol Davila
Farshad Farzadfar: Tehran University of Medical Sciences
Corine Houehanou: University of Abomey-Calavi
Abla Sibai: American University of Beirut
Andrew C. Stokes: Boston University
Demetre Labadarios: Stellenbosch University
Mongal Gurung: Ministry of Health
Jutta Jorgensen: University of Copenhagen
Khem Karki: Tribhuvan University
Nuno Lunet: University of Porto
Sahar Saeedi Moghaddam: Tehran University of Medical Sciences
Kibachio J. Mwangi: Ministry of Health
Lela Sturua: National Center for Disease Control and Public Health
Till Bärnighausen: Heidelberg University
David Flood: University of Michigan
Pascal Geldsetzer: Stanford University
Albertino Damasceno: University of Eduardo Mondlane
Justine Davies: University of Birmingham
Mohammed K. Ali: Emory University
Jennifer Manne-Goehler: Brigham and Women’s Hospital
Caroline Bulstra: Heidelberg University

Nature Communications, 2025, vol. 16, issue 1, 1-8

Abstract: Abstract Given rising diabetes prevalence globally, access to diabetes treatments is gaining urgency. Yet, it remains unknown which glucose-lowering medication types people with diabetes across low- and middle-income countries (LMICs) use. In this cross-sectional analysis, we pooled nationally representative data of 223,283 adults aged ≥25 years in 62 LMICs from 2009 to 2019. We found that 51.9% [95%-CI: 49.6%, 54.2%] of 21,715 individuals with diabetes were undiagnosed. Among individuals with diagnosed diabetes, 18.6% [95%-CI: 14.5%, 23.4%] reported using no glucose-lowering medication, 57.3% [95%-CI: 53.1%, 61.4%] only used oral medication, 19.5% [95%-CI: 17.6%, 21.5%] used oral medication and insulin, and 4.7% [95%-CI: 3.9%, 5.6%] used insulin alone. In low-income countries, fewer individuals with diabetes were diagnosed and treated than in middle-income countries. Yet, among individuals who did get diagnosed, insulin use was two-thirds higher in low-income countries (38.9% [95%-CI: 31.6%, 46.7%]) compared to middle-income countries (23.2%; 95%-CI: 21.0%, 25.5%]). This finding could suggest a need for earlier diagnosis and treatment initiation. Our results can inform national and regional drug procurement efforts across LMICs.

Date: 2025
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DOI: 10.1038/s41467-025-59123-4

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